Africa: End of AIDS in Sight, 2

Editor's Note

"As leaders and scientists prepare to discuss the latest
initiatives needed to scale up treatment to such a high
level it could potentially end the epidemic, seven million
people still require urgent access to antiretroviral (ARV)
treatment. While the United Nations AIDS agency (UNAIDS)
estimates that 1.4 million more people were put on
antiretroviral therapy in 2011, this pace will have to
double to reach the global goal of 15 million people
receiving treatment by 2015." - Doctors without Borders

Amid the plethora of reports, commentaries, meetings, and
demonstrations this week at the International AIDS
Conference in Washington, the consensus was wider than ever
that success against the AIDS pandemic is in sight, but only
if existing knowledge is applied with sufficient resources
and commitment.

Two AfricaFocus Bulletins today select among the most
readable and informative reports and commentaries appearing
during the week.

This AfricaFocus Bulletin, not sent out by e-mail but
available on the web at http://www.africafocus.org/docs12/hiv1207b.php, contains (1)
a report from PlusNews focused on increases in domestic
investment on AIDS in affected African countries, (2) a
commentary from Doctors without Borders on the need for
stepped-up commitment by donors, (3) a news release from
Kaiser Family Foundation and UNAIDS on trends in donor
financing, and (4) a commentary from Huffington Post on how
U.S. Trade policy is undermining the prospects for
affordable generic drugs for AIDS and other diseases.

Another AfricaFocus Bulletin, sent out by e-mail today and
available on the web at http://www.africafocus.org/docs12/hiv1207a.php, contains
several other recent articles, including (1) a summary
article from PlusNews on the prospects for an "and to AIDS,"
(2) an op-ed by Anthony Fauci on the same theme, (3) an
analysis by AIDS activist Mark Harrington on the Obama
administration response to the AIDS pandemic, with proposals
for additional action.

Africa: Domestic investment in HIV up but uneven

Nairobi, 19 July 2012 (PLUSNEWS) - Many sub-Saharan African
nations - traditionally the beneficiaries of international
HIV funding - are gradually increasing their financial
contributions to the fight against the virus, boosting the
number of people on treatment to record highs according to a
new UNAIDS report, Together We Will End AIDS
[http://www.unaids.org], released on 18 July.

Low- and middle-income countries invested US$8.6 billion in
the response in 2011, an increase of 11 percent compared to
2010, whereas the international community contributed $8.2
billion, a figure that has remained flat since 2008. The
United States contributed nearly half of all international
assistance for HIV/AIDS.

Increased local funding

In several African countries, including Kenya, Namibia,
Sierra Leone and Uganda, domestic spending on HIV/AIDS rose
by more than 100 percent between 2006 and 2011. In Botswana,
Comoros, Mauritania, Mauritius, the Seychelles and South
Africa, domestic investment accounted for more than 70
percent of AIDS funding.

The increases in funding allowed a record 6.2 million
Africans to access life-prolonging antiretroviral treatment
in 2011, compared to 5.1 million in 2010. The most
impressive numbers in 2011 were seen in South Africa, which
initiated 300,000 people on treatment, Zimbabwe (150,000)
and Kenya (100,000). The recently released 2012 UN
Millennium Development Goals report notes that Botswana,
Namibia and Rwanda have achieved universal access to ARVs.

Increased access to ARVs has also helped reduce new HIV
infections, with research showing that the medication
reduces the transmission risk of people living with HIV.
According to UNAIDS, new HIV infections have declined
globally by 20 percent since 2011.

Since 2009, new infections in children have fallen by an
estimated 24 percent. An estimated 330,000 children were
infected with HIV in 2011, about half the number of those
newly infected in 2003, the year considered the peak of the
epidemic.

But the increased spending has failed to close a large gap
in global funding for HIV, estimated to reach $7 billion by
2015, which is significantly short of the $24 billion target
set at the 2011 UN High Level Meeting on AIDS. UNAIDS says a
"concerted effort by all countries is needed to scale up
funding if this target is to be met".

Not enough

In 2011, the Global Fund to Fight AIDS, Tuberculosis and
Malaria took the unprecedented decision of cancelling its
11th round of funding after donors failed to meet
commitments, denting treatment programmes in many countries.

He pointed out that "In places where we work, we see how
fragile the progress is that has been achieved over the last
decade. Health ministries are working hard to implement the
latest treatment recommendations and policies to get ahead
of the wave of new infections, but they can't do it alone."

Domestic spending by African governments has been uneven. In
Malawi, which has an ambitious plan to put half a million
people on ARVs by 2014, the treatment programme is almost
entirely donor-funded - the government foots just five
percent of its HIV bill - and the country's Global Fund
grant comes to an end in 2014.

"The government is committed to fighting HIV, but the
economy is not good at the moment and we rely completely on
donors. Our programmes are running very well, but without
donor support we can't manage on our own," Stuart Chuka,
national HIV/AIDS programme officer in Malawi's Ministry of
Health, told IRIN/PlusNews.

Need for continued support

"The cost of the ARV programme is almost the same as the
total annual national health budget. For our human resources
for health, we already have a problem, but with the Global
Fund money running out it is going to be quite difficult -
the money had helped us hire and retain more workers," he
said.

Chuka noted that the country had adopted the latest UN World
Health Organization guidelines to switch from the ARV,
stavudine, to tenofovir (TDF) in first-line drug regimens,
but insufficient resources meant not everyone could be put
on the new drug. HIV-positive pregnant women, patients coinfected
with HIV and TB, and those with severe reactions to
stavudine are being prioritized.

In the Democratic Republic of Congo (DRC), a major World
Bank project closed in 2011 after six years, while UNITAID,
an international health financing mechanism for paediatric
and second-line ARVs, will end its funding to the DRC in
December 2012. The US President's Emergency Plan for AIDS
Relief (PEPFAR) provides ARVs for prevention of mother-tochild
transmission, but only for 18 months, after which
patients are expected to be absorbed into the Global Fund's
programmes.

The Global Fund - the major donor to DRC's HIV fight -
expects to put some 32,000 new patients on ARVs by the end
of 2014, but at least 430,000 people need the drugs. Just
12.3 percent of people who need ARVs have access to them,
and MSF warns that unless more money is invested, ARV
coverage will remain below 25 percent in 2015.

"One of the major problems is delays in seeking treatment -
people in the DRC still pay between $15 and $25 for a CD4
test [a measure of immune strength]. At the MSF hospital in
Kinshasa we are seeing at least one death per day - 50
percent of these are people who arrived 48 hours earlier - a
clear sign of problems in HIV testing," said Thierry
Dethier, advocacy officer for MSF in DRC. "Due to the
shortage of international support, the government seems
afraid to roll out its national testing programme, because
it cannot assure HIV-positive patients of treatment."

Agencies working in DRC are hoping to see the government
allocate at least $7 million to HIV/AIDS in this year's
budget, as well as increased spending on health, which has
not exceeded 6 percent of the national budget in the last
decade.

Donors must commit to fight the HIV emergency

Johannesburg, 19 July 2012 - New United Nations data about
gains made in the fight against HIV/AIDS is sparking
optimism ahead of the 2012 International AIDS Conference in
Washington. But countries most affected by the pandemic
still struggle to place enough people on treatment and to
implement the best science and strategies to fight the
disease, Médecins Sans Frontières (MSF) warned today.

As leaders and scientists prepare to discuss the latest
initiatives needed to scale up treatment to such a high
level it could potentially end the epidemic, seven million
people still require urgent access to antiretroviral (ARV)
treatment. While the United Nations AIDS agency (UNAIDS)
estimates that 1.4 million more people were put on
antiretroviral therapy in 2011, this pace will have to
double to reach the global goal of 15 million people
receiving treatment by 2015. At the same time, international
discourse is increasingly urging Africans to find their own
domestic solutions to the HIV emergency.

African states cannot combat HIV alone

"It would be outrageous to assume that African states could
combat this emergency alone, given their current limited
resources," said Dr Eric Goemaere, MSF's HIV/AIDS senior
regional advisor for southern Africa. "This is just a
cynical excuse for donors to scale back on their earlier
commitments of putting an end to this disease. It will have
catastrophic consequences for patients."

In the Democratic Republic of the Congo (DRC), less than 15
per cent of patients who need ARV therapy receive it, 11 per
cent of health facilities offer treatment, and less than 6
per cent of HIV-positive mothers have access to ARV drugs to
prevent their children from becoming infected.

"We receive critically ill patients who have desperately
searched for ARV treatment," said Thierry Dethier, MSF's
advocacy manager in DRC. "For too many, their disease has
progressed so far that they are literally dying on our
doorstep."

International support stagnates

Several governments have taken important and courageous
steps to address the HIV pandemic. Zimbabwe and Malawi have
made major progress in broadening treatment programs in
recent years. Malawi was the first country in Africa to
implement prevention of mother-to-child transmission
protocols, which foresee lifelong treatment for HIV-positive
expectant or lactating mothers. Mozambique recently
recommended a similar protocol, prescribing better firstline
treatment and monitoring treatment progress by using
viral load testing.

Yet, plans for scaling up treatment and improving quality of
care risk being scrapped entirely as international support
stagnates, with donors turning a blind eye to their earlier
commitments. Important institutions in fighting the pandemic
like the Global Fund are facing major funding shortfalls due
to waning donor interest.

"In Malawi we're committed to implementing programmes based
on recent scientific progress," said Stuart Chuka, national
ARV treatment programme officer from the Malawi Ministry of
Health. "Yet just as success is within reach, we're up
against a great financial squeeze. I truly believe that we
can end AIDS. But we can't do it alone."

Donor nation support for HIV stands firm but investments
remain at 2008 levels

U.S. continues to account for more than half of all donor
government investments

Washington, D.C., July 18, 2012- Donor nation funding in
2011 for HIV in low- and middle-income countries returned to
prior levels after a drop in 2010, but has been roughly flat
since the recession hit world economies in 2008, according
to an annual funding analysis from the Kaiser Family
Foundation and the Joint United Nations Programme on
HIV/AIDS (UNAIDS).

The study found that donor governments disbursed US$ 7.6
billion in 2011 for the AIDS response in low- and middleincome
countries. Overall donor government support for AIDS
has been flat since 2008, which marked the end of rapid
increases in donor disbursements of more than six-fold over
the 2002 to 2008 period.

"International investments still account for two thirds of
funding for HIV in Africa, the continent most affected by
the epidemic," said Paul De Lay, Deputy Executive Director,
Programme at UNAIDS. "Although more and more countries are
increasing domestic investments for HIV, investments from
donor governments remain an essential resource."

"The benefits of early detection and treatment have never
been more clear, but countries have never been more
challenged to provide needed resources. This is a critical
time to keep the focus on the HIV epidemic," said Drew
Altman, Kaiser Family Foundation President and CEO.

The two largest donor governments â the United States and
United Kingdom â reported funding increases. The United
States, the largest donor nation, reported a US$785 million
increase in disbursements over 2010, but only returned to
2009 levels after reporting a delay in disbursements as the
reason for last year's decline. Australia, Canada, Denmark,
France, Germany, Norway and Sweden maintained or slightly
increased their support, while Ireland, Italy, Japan and the
Netherlands decreased funding.

In 2011, the United States accounted for more than half
(59.2%) of total donor government disbursements, followed by
the United Kingdom (12.8%), France (5.4%), the Netherlands
(4.2%), Germany (4.0%) and Denmark (2.5%).

When considering what constitutes a donor's "fair share" â
which this report assesses by looking at donor resources
standardized by the size of government economies â Denmark
provided the highest amount of resources for AIDS in 2011,
followed by the United Kingdom, the Netherlands, Ireland and
Sweden. The United States was sixth.

According to the latest estimates from UNAIDS, 34.2 million
(31.8-35.9 million) people were living with HIV at the end
of 2011. Nearly 35 million have died from AIDS-related
causes since AIDS was first reported 31 years ago.

The new report provides that latest data available on donor
funding based on data provided by governments, and were
collected and analyzed by researchers as part of a
collaborative effort between the Kaiser Family Foundation
and UNAIDS.

International AIDS Conference Sparks Protest Of Obama Trade
Policies

[For additional background on this issue, see the Issue
Brief from Doctors without Borders, "Trading Away Health,"
published this week and available athttp://tinyurl.com/cdpcaw9}

Washington -- Thousands of people marched on the White House
and the Office of the U.S. Trade Representative on Tuesday
to protest a new trade agreement that public health experts
warn would cut off access to life-saving medications for
AIDS patients.

The protests are tied to the International AIDS Conference,
a week-long event in the nation's capital devoted to
improving global treatment programs, sharpening public
policies and ending the disease. Thirteen people were
arrested after hanging AIDS ribbons on the White House fence
and refusing to clear the street in front of the White
House. Thousands of others decamped across the street to
Lafayette Park, chanting, "Obama, come out, we've got some
sh*t to talk about!"

Activists in Washington this week are demanding a handful of
policy changes related to HIV/AIDS, including immediate
treatment for the thousands of low-income Americans
currently on waiting lists for HIV drugs, the full
implementation of Obama's domestic health care reform bill,
increased global AIDS relief funding and an end to free
trade agreements that inflate the prices of drugs around the
world by granting long-term monopolies to pharmaceutical
companies.

Hundreds of public health organizations have backed the
agenda, which is posted online at http://wecanendaids.org.
Many were present at the protests, including representatives
of the American Medical Student Association.

Nevertheless, President Barack Obama's administration has
opposed many of policy changes, cutting global AIDS funding
under the popular PEPFAR program, while pursuing trade
policies that economists say increase the prices of AIDS
medications, cancer drugs and other life-saving medications
both at home and abroad.

By contrast, Obama's Affordable Care Act contains a host of
provisions to broaden and lower the cost of domestic health
insurance. Those policies should make insurance more widely
available and less expensive for HIV patients. Obama's trade
policies, however, could ultimately increase the cost of
that insurance.

Trade protesters were especially prominent at the
afternoon's event. Several held banners objecting to the
Trans-Pacific Partnership, a major trade deal that the Obama
administration has been negotiating with 10 Pacific nations
for the past three years. According to leaked drafts of the
talks, American negotiators are pursuing a host of
intellectual property terms that would lengthen drug company
monopolies on medications, including drugs introduced in
Vietnam, a developing nation that receives PEPFAR funding
from the U.S. These policies, in turn, put upward pressure
on drug prices all over the world. The negotiating texts for
the trade pact are kept secret from the public, but more
than 600 corporate advisers, including representatives of
drug companies, can access them through positions on
official advisory boards.

"Fire Ron Kirk!" protesters chanted Tuesday, referring to
the head of the Office of the U.S. Trade Representative, the
agency formally tasked with negotiating the deal.

UNAIDS, the United Nations' anti-AIDS group, also criticized
the policies being pursued under TPP in a June report.

Doctors Without Borders released a new report to coincide
with the conference, analyzing leaked provisions of the TPP,
which concludes, "If the U.S.'s demands are accepted, the
TPP agreement will impose new IP rules that could severely
restrict access to affordable, life-saving medicines for
millions of people."

USTR spokesperson Carol Guthrie told HuffPost her agency is
taking into account feedback on its efforts, including
feedback from Tuesday's protests. "USTR has gotten a great
deal of feedback on our early TPP proposals and we are in
fact reflecting carefully on it, and want to continue to
work with all stakeholders on getting this policy right,"
Guthrie said, pointing to a recent Kirk-penned blog post
that emphasized the need to balance the intellectual
property incentives for drug companies with the treatment
concerns.

She also pointed to a Sunday statement from the White House
that said, "The Obama Administration remains steadfast in
its commitment to people living with, or affected by, HIV
throughout the world."

But such statements appeared to hold little comfort for the
protesters on Tuesday, who carried signs declaring, "PFIZER
+ OBAMA'S TPP = DEATH FOR PEOPLE WITH AIDS," and "RON KIRK:
TRANS-PACIFIC TRADE DEAL KILLS."

The protests are particularly pointed for the Obama
administration for taking place in Washington, where the
president is more popular than in any state in the nation.
Yet the district features a higher AIDS/HIV rate than any
other area of the country, making AIDS policy issues a
matter of deep significance to the city's residents. At 3.2
percent, the HIV infection rate in D.C. is more than triple
the rate the World Health Organization uses to identify
epidemics, and is higher than the rate in many developing
nations.

Doctors have long known that HIV drugs can prolong a
patient's life for decades. But access to such medicines
became an even higher priority issue over the past year,
after research was published showing the medications were
also 96 percent effective at preventing transmission of the
disease to others.

AfricaFocus Bulletin is an independent electronic
publication providing reposted commentary and analysis on
African issues, with a particular focus on U.S. and
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William Minter.

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